Basic Information
| Provider Information | |||||||||
| NPI: | 1073516985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLIVERIO | ||||||||
| FirstName: | ROSEANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 199 PARK CLUB LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168364646 | ||||||||
| FaxNumber: | 7168364696 | ||||||||
| Practice Location | |||||||||
| Address1: | 199 PARK CLUB LN STE 300 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168364646 | ||||||||
| FaxNumber: | 7168364696 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 12/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 161644 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | 161644 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000527990007 | 01 | NY | HEALTHNOW, INC. | OTHER | 01655985 | 05 | NY | MEDICAID | MDH207 | 01 | NY | PREFERRED CARE - ROCHESTE | OTHER | P010161644 | 01 | NY | BLUE CHOICE / BLUE SHIELD | OTHER | 4165918 | 01 | NY | GHI PPO | OTHER | 00025673502 | 01 | NY | UNIVERA | OTHER | 1609172 | 01 | NY | IHA | OTHER |